Design, delivery, and determinants of uptake: findings from a food hygiene behavior change

Sobhan et al. BMC Public Health (2022) 22:887

https://doi.org/10.1186/s12889-022-13124-w

RESEARCH ARTICLE

Design, delivery, and determinants

of uptake: fndings from a food hygiene

behavior change intervention in rural

Bangladesh

Shafnaz Sobhan1,2* , Anna A. Müller‑Hauser1,2,3 , Tarique Md. Nurul Huda4 , Jillian L. Waid2,3 ,

Om Prasad Gautam5 , Giorgia Gon6 , Amanda S. Wendt2,3 and Sabine Gabrysch1,2,3

Abstract

Background: Microbial food contamination, although a known contributor to diarrheal disease and highly prevalent

in low-income settings, has received relatively little attention in nutrition programs. Therefore, to address the criti‑

cal pathway from food contamination to infection to child undernutrition, we adapted and integrated an innovative

food hygiene intervention into a large-scale nutrition-sensitive agriculture trial in rural Bangladesh. In this article, we

describe the intervention, analyze participation and uptake of the promoted food hygiene behaviors among interven‑

tion households, and examine the underlying determinants of behavior adoption.

Methods: The food hygiene intervention employed emotional drivers, engaging group activities, and household

visits to improve six feeding and food hygiene behaviors. The program centered on an ‘ideal family’ competition.

Households’ attendance in each food hygiene session was documented. Uptake of promoted behaviors was assessed

by project staf on seven ‘ideal family’ indicators using direct observations of practices and spot checks of household

hygiene conditions during household visits. We used descriptive analysis and mixed-efect logistic regression to

examine changes in household food hygiene practices and to identify determinants of uptake.

Results: Participation in the food hygiene intervention was high with more than 75% attendance at each session.

Hygiene behavior practices increased from pre-intervention with success varying by behavior. Safe storage and fresh

preparation or reheating of leftover foods were frequently practiced, while handwashing and cleaning of utensils was

practiced by fewer participants. In total, 496 of 1275 participating households (39%) adopted at least 5 of 7 selected

practices in all three assessment rounds and were awarded ‘ideal family’ titles at the end of the intervention. Being

an ‘ideal family’ winner was associated with high participation in intervention activities [adjusted odds ratio (AOR):

11.4, 95% CI: 5.2–24.9], highest household wealth [AOR: 2.3, 95% CI: 1.4–3.6] and secondary education of participating

women [AOR: 2.2, 95% CI: 1.4–3.4].

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Open Access

*Correspondence: [email protected]

1

Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate

member of Freie Universität Berlin and Humboldt-Universität zu Berlin,

Charitéplatz 1, 10117 Berlin, Germany

Full list of author information is available at the end of the article